PDD NOS

PDD-NOS

There are five pervasive developmental disorders in the Diagnostic Statistical Manual, Fourth Edition (DSM-IV) including autism and PDD-NOS. The terminology can be confusing with regards to the autism spectrum of disorders, especially when trying to define autism. The PDD category in the DSM IV is complex, making identification of certain conditions difficult.

Pervasive Developmental Disorders

Pervasive developmental disorder is a category in the DSM-IV that outlines the different disorders on the autism spectrum. It is important to recognize that an individual can be diagnosed on the autism spectrum without meeting all the criteria for an autism diagnosis. The first step to understanding the terminology is to make a distinction between PDD and PDD-NOS.

PDD and PDD-NOS

Pervasive developmental disorder is a category that includes five conditions, including autism and Asperger syndrome. Pervasive developmental disorder-not otherwise specified (PDD-NOS) is a specific diagnosis within this category. Some refer to the PDD-NOS as a subthreshold condition that has some of the characteristics of other disorders in the autism spectrum, but not all of them. Basically, people with this diagnosis have some of the symptoms of other autistic conditions but they do not have enough to fit in the autism, Asperger, Rett or childhood degenerative disorders. The diagnosis may be considered a catchall by some, but it is still a significant condition that requires proper treatment.

Atypical Autism

Pervasive developmental disorder-not otherwise specified goes by a number of different names. Some refer to the condition as atypical autism because the individual has some autistic characteristics and the diagnosis falls within the autism spectrum. Other terms commonly associated with this diagnosis include atypical personality development and atypical PDD.

Criteria for Diagnosis

No matter what the designation, specific criteria must be met in order for a diagnosis to be made. It is imperative to have a complete physical by a licensed physician to rule out medical conditions that can have symptoms similar to autism.

Symptoms can include:

  • Significant impairment in communication
  • Lack of eye contact
  • Self-stimulatory behaviors or repetitive movements
  • Unusual focus on certain interests
  • Significant impairment of social interaction
  • Rigid patterns of behavior

There are no specific guidelines for the diagnosis of PDD-NOS. For example, one child may have significant problems with communication but does not engage in self-stimulatory behaviors. Another may have appropriate communication skills but significant impairments in social interaction.

Level of Severity

Individuals who have this diagnosis exhibit a range of severity in symptoms. Some cases are quite mild while others are very severe. Many think that all cases of PDD-NOS are high functioning but many are not. Severe detriments in language and social development are possible within this diagnosis.

Whether severe or not, children do not exhibit typical childhood behavior. Identifying the condition begins with recognizing the unusual behaviors and symptoms that are characteristic of the autism spectrum of disorders.

Using the Childhood Autism Rating Scale

The Childhood Autism Rating Scale (CARS) is an excellent tool for identifying symptoms of autism in children. This questionnaire addresses specific issues including play, social interaction, communication skills, and behaviors. Part of the process of diagnosing the condition relies on the answers provided by parents about their children. The physician rates the child's functioning in 15 categories on a scale of one to four. The categories fall under the following topics of concern:

  1. Social development
  2. Physical development
  3. Transitions and change
  4. Auditory processing
  5. Verbal Communication

Importance of Reevaluations

Whether the individual displays high functioning or low functioning behaviors, it is important to have regular reevaluations. The evaluations help determine the ideal treatment approaches and teaching strategies since they can change overtime.

The individual's treatment team consists of parents, educators, therapists, caseworkers and physicians. Each should be a part of evaluations and reevaluations.

Individualized Diagnoses

While it may seem as though a diagnosis of PDD-NOS like a catchall, it's important in providing insight into the common bonds people with pervasive developmental disorders share. Once a diagnosis of PDD-NOS is determined from these shared symptoms, concentration on individualized symptoms can make the difference in how each individual with autism receives care.